Cytomegalovirus Retinitis and Retinal Detachment following Chimeric Antigen Receptor T Cell Therapy for Relapsed/Refractory Multiple Myeloma

Abstract

Cytomegalovirus (CMV) retinitis is a rare end-organ disease of CMV infection and is a marker of severe immunosuppression, especially in human immunodeficiency virus (HIV)-positive patients. In multiple myeloma (MM) patients, CMV retinitis has been reported in the post-transplant setting, with an incidence lower than 0.2%, and in patients receiving lenalidomide. Here, we describe the first case of CMV retinitis in myeloma patients following B-cell maturation antigen (BCMA)-targeted chimeric antigen receptor T (BCMA CAR-T) cell therapy. In addition to CMV, the patient developed multiple infections including a mouth ulcer, pneumonia, and fungal enteritis. While the complete remission (CR) status of MM was maintained, he regained a visual acuity of 20/1000 after appropriate ophthalmologic treatment. This single case illustrates the potential of BCMA CAR-T therapy to induce profound humoral immunosuppression, and demonstrates an imperative need for an established standard of monitoring and prophylaxis of post-CAR-T infections.

Keywords: chimeric antigen receptor T cells; cytomegalovirus infection; multiple myeloma; retinal detachment; retinitis.

Figure 1

A timeline of the case. (A) Post-CAR-T flow cytometry of bone marrow sample and PET-CT confirmed the complete remission of multiple myeloma. (B) Anterior segment examination and fundoscopy at the diagnosis of CMV retinitis. (C) Ultrasonography of the right eye confirmed retinal detachment. (D) Fundoscopy after the removal of silicone oil tamponade, showing recovery from CMV retinitis and retinal detachment.